title: Cotton-clipping technique to repair intraoperative aneurysm neck tear: a technical note.
abstract: BACKGROUND
  Intraoperative rupture of an intracranial aneurysm is a potentially devastating but avoidable and manageable complication of aneurysm surgery.
  
  
  OBJECTIVE
  To describe a surgical technique that the authors have used successfully to repair a tear at the neck of an intracranial aneurysm, as well as alternative options for managing this intraoperative complication.
  
  
  METHODS
  The tear on the neck of the aneurysm is covered with a small piece of free cotton and held in place with a suction device to clear the field of blood. The cotton is then clipped onto the tear with an aneurysm clip, using the cotton as a bolster to obliterate the tear. The cotton increases the surface area, allowing the clip to be placed more distally on the neck to preserve patency of the parent artery. Case examples are used to illustrate the technique.
  
  
  RESULTS
  Both authors independently have used this technique on several occasions to successfully repair tears at the neck of an aneurysm.
  
  
  CONCLUSIONS
  Intraoperative rupture of an intracranial aneurysm is a potentially devastating complication, particularly if a tear occurs at the neck. This simple yet effective method has been very useful in repairing a partial avulsion or tear of the neck of an aneurysm.
authors.affiliation: Department of Neurosurgery Emory University School of Medicine, 1365-B Clifton Road N.E., Atlanta, GA 30322, USA. daniel.barrow@emoryhealthcare.org
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Barrow
authors.forename: Robert F
authors.initials: RF
authors.lastname: Spetzler
mesh_terms: D017542:Aneurysm, Ruptured / Q000209:etiology / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000601:surgery*; D002533:Cerebral Angiography; D032561:Cotton Fiber; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery*; D007431:Intraoperative Complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery; D013345:Subarachnoid Hemorrhage / Q000209:etiology / Q000601:surgery; D013525:Surgical Instruments